As commissioners and social workers, in our local authority next week we will be asking ourselves the question – who do we know about in an ATU who we have responsibility for and what are we doing to get them home?

There are several reasons for this, which are not given as an excuse, but hopefully will help shed some light on some of the issues faced by social workers and local authority commissioners which other, clever people than us, can help us with.

Firstly, the lead commissioners for placements in ATU’s aren’t from Local Authorities. Inpatient admissions for adults with a learning disability are commissioned by health services (NHS England and/or the CCG). CCG commissioning leads responsible for inpatient admissions, are also usually the people who lead on commissioning of Continuing Health Care funded community support. Sometimes the Ministry of Justice are also involved.

Health commissioners do not as a matter of course share details with Local Authority commissioners about who they have placed where. There are lots of explanations for this – but I suspect the most important one is that on a day to day basis CHC is the fault line which divides health and social care. CHC is the single biggest barrier to integrating a seamless, personalised support model around the person which puts them in full control of their support. CHC is controlled to the nth degree – see the really quite odd policy position of CCGs “creating a local Personal Health Budget offer” for how you can choose to spend your PHB- https://www.england.nhs.uk/healthbudgets/understanding/rollout/ – either you are in control or you aren’t – an “offer” defined and limited by commissioners is not personalisation as self-advocacy groups define it. The conflict on the front line generated by very different, deeply held assumptions between health and social care about who should be in control of defining what support is offered to get someone home, and crucially who has to pay for it, isn’t conducive to building the sort of trusting relationships required to foster cultures of collaboration.

And at the top of the 4th tier, there are 6 catagories…. Confused yet…? Still with me…? See the Royal College of Psychiatrist’s explanation of why ATU isn’t a good description for forensic inpatient services as it is ‘more complicated than that’ – http://www.rcpsych.ac.uk/pdf/FR%20ID%2003%20for%20website.pdf

category 6: other beds including those for specialist neuropsychiatric conditions

As a local authority social worker or commissioner the focus of any discussion with a CCG CHC Lead who is tasked with arranging for a discharge from an ATU is about how commissioners arrange for people to ‘step down the tiers’. This is code for how people move through the funding system from the NHS to social care paying for the person’s support. This is particularly important given the Transforming Care agenda – to qualify for what NHS England have oddly chosen to call ‘dowry’ funding (I find the use of the word dowry to be a very odd one indeed in the context of getting people home from hospital), people need to have been resident in an ATU for over 5 years.

According to Chris Hatton’s figures – https://theatuscandal.wordpress.com/some-atu-facts-figures/ only 17% of people currently in ATUs would qualify for these funds. Clarity over how the support home is going to paid for the other 83% of people is a hugely important issue if we are to be able to make it happen for the 3,000 people who just want to go home. If I was a policy maker, I would do something very simple – I would mandate CCG spend on learning disabilities into the Better Care Fund (the finance data was collected last summer by NHS England so they know what they need to do to make this happen….)

So, what could you do as a social worker or local authority commissioner during the week:

Of these, find out how many meet the definition for support to get home under the national Transforming Care programme

Ask who the allocated social worker and commissioner are who is working to get the person home

Speak to those workers and ask them, what specific plan is in place to get the person home and what can you do to help them make this happen

As a team, ask the CCG commissioners to confirm exactly how many people are the CCG are aware of within ATUs – and to confirm this number with NHS England who need to confirm it with the Ministry of Justice

Don’t be confused by the noise – it is only complicated if you chose to let it be